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Dr. Arlow asserts that unreality feelings are not a source of anxiety but a means of warding it off. According to Schur, however, careful clinical study shows that while unreality feelings initially ward off anxiety, they in turn become feared in themselves and give rise to further defenses. A vicious cycle ensues, resulting in a stratification of dangers that may contribute to the spread and deterioration of the neurotic symptom.
Both papers confine preoedipal influences to causation of borderline and psychotic conditions and consider signal anxiety and neurotic symptom formation as only deriving from Oedipal-level conflict. Zetzel suggests that many recent studies show that preoedipal and Oedipal influences contribute equally to neurotic symptom formation.
Loewenstein says that the strength or weakness of the drive relative to the ego may lead to symptom formation but there can be other important influences such as the qualitative factor of pregenital predominating over genital drives, the inappropriateness of the defenses to the particular reality the patient faces, or the stability in the defenses or lack of it. Defenses may have a complicated history, originally having an adaptive function, later serving defensive purposes, and still later becoming instinctualized. Finally, beyond the underlying intersystemic conflicts are frequently intrasystemic ones within the ego itself as, for instance, in cases of intense anxiety attacks based on fear of the ego's loss of control over its functions.
A woman responding favorably to Kleinian analysis illustrates how early experiences can mold the Oedipal pattern. Langer thinks that Lampl-de Groot's remarks on the importance of the early mother-child relationship and of the quantitative relationship between the drives, their fusion and defusion, important in depressive and paranoid states may make possible an integration with Kleinian concepts. Arlow's example of manifest orality covering latent Oedipal fantasy seems a c